Balance billing

Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays.[1] It is a pervasive practice in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty.

Advocates of balance billing argue that it increases the incomes of high-quality healthcare providers and measures their dissatisfaction with insurance company fees.[2] Critics say that balance billing lets providers raise charges through stealth rather than transparent pricing, creates unnecessary administrative costs and patient confusion, and allows providers to simply pass along costs to patients, rather than helping them to secure good value.[3] It is thought to erode political consensus in favor of a one-tier system of healthcare, and to inhibit some people from getting the care they need, by making that care more expensive.[4]

  1. ^ "Balance Billing - HealthCare.gov Glossary". HealthCare.gov. Retrieved 2019-10-23.
  2. ^ Holahan, John, Lynn Etheredge (1986). Medicare physician payment reform: issues and options. Washington DC: The Urban Institute. p. 109. ISBN 978-0-87766-395-9.{{cite book}}: CS1 maint: multiple names: authors list (link)
  3. ^ Porter, Michael E., Elizabeth Olmsted Teisberg (2006). Redefining health care: creating value-based competition on results. Boston, Massachusetts: Harvard Business School Press. p. 338. ISBN 978-1-59139-778-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  4. ^ Bennett, Arnold, Orvill Adams, Families United for Senior Action Foundation (1993). Looking north for health: what we can learn from Canada's health care system. Jossey-Bass/Aha Press Series. p. 173. ISBN 978-1-55542-516-6.{{cite book}}: CS1 maint: multiple names: authors list (link)